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钝性创伤后出现结肠绞窄但漏诊膈肌损伤:一种罕见情况。

Missed diaphragmatic injury after blunt trauma presenting with colonic strangulation: a rare scenario.

作者信息

Kumar Atish, Bagaria Dinesh, Ratan Amulya, Gupta Amit

机构信息

Department of Surgery, All India Institute of Medical Sciences, New Delhi, India.

Department of Trauma Surgery, All India Institute of Medical Sciences New Delhi, New Delhi, India.

出版信息

BMJ Case Rep. 2017 Aug 7;2017:bcr-2017-221220. doi: 10.1136/bcr-2017-221220.

Abstract

Diaphragmatic rupture occurs in 4%-5% cases of thoracoabdominal injuries. It may present acutely, in a delayed fashion or as a complicated hernia. We are describing the case of a young male presenting in respiratory distress with history of chest trauma 1.5 years back. On investigation, he was found to have left side diaphragmatic hernia containing gangrenous colon with lung collapse. The patient underwent successful operative intervention and discharged after 25 days of hospital stay. Record review suggested that the above mentioned diaphragm injury was missed in his evaluation 1.5 years back. Diaphragmatic injury must always be suspected in thoracoabdominal injuries, as missed injury may cause devastating complications like the one narrated above in due course.

摘要

膈肌破裂发生于4% - 5%的胸腹联合伤病例中。它可能急性出现、延迟出现或表现为复杂的疝。我们在此描述一名年轻男性的病例,该患者因1.5年前胸部外伤史而出现呼吸窘迫。经检查,发现他患有左侧膈肌疝,疝内容物为坏疽性结肠并伴有肺萎陷。患者接受了成功的手术干预,住院25天后出院。病历回顾显示,1.5年前对其评估时漏诊了上述膈肌损伤。在胸腹联合伤中必须始终怀疑存在膈肌损伤,因为漏诊的损伤可能在病程中引发如上述所描述的灾难性并发症。

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本文引用的文献

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Traumatic diaphragmatic hernia: tertiary centre experience.创伤性横膈疝:三级中心经验。
Hernia. 2010 Apr;14(2):159-64. doi: 10.1007/s10029-009-0579-x. Epub 2009 Nov 12.
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Traumatic diaphragmatic rupture: look to see.创伤性膈肌破裂:仔细观察。
Eur J Cardiothorac Surg. 2008 Jun;33(6):1082-5. doi: 10.1016/j.ejcts.2008.01.029. Epub 2008 Mar 4.
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Blunt diaphragmatic rupture: four year's experience.钝性膈肌破裂:四年经验
Hernia. 2008 Feb;12(1):73-8. doi: 10.1007/s10029-007-0283-7. Epub 2007 Sep 22.
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Missed diaphragmatic injuries and their long-term sequelae.漏诊的膈肌损伤及其长期后遗症。
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